A woman complained about the care provided to her late husband by a
hepatobiliary surgeon and a private hospital.

The complaint was that the surgeon: did not perform a biopsy to
establish his diagnosis prior to performing surgery; did not have a
consent form signed by the 52-year-old patient prior to operating;
did not continue oxygen treatment despite low oxygen saturations;
did not investigate and treat appropriately, or facilitate a second
opinion, when the patient's condition deteriorated; and did not
inform the public hospital of the patient's transfer. In addition,
that staff at the private hospital failed to provide appropriate
care and treatment in a timely manner.

Independent advice was obtained from a consultant general and upper
gastrointestinal surgeon. A preoperative liver biopsy would not
have assisted in determining the problem or confirming the correct
course of action. Such a biopsy is difficult to perform and, if a
malignancy is present, may assist in spreading cancer cells. Oxygen
treatment would have made little difference to the patient's
overall condition.

The surgeon breached Rights 4(1) and 4(2) in failing to ensure that
the patient received care of an appropriate standard
postoperatively with regard to:

(1) fluid management, as the patient was inappropriately prescribed
sodium-rich saline; (2) the failure to seek a second opinion when
the patient's condition was not improving and the family had
expressed concern; (3) insufficient efforts to exclude covert
sepsis; and (4) failing to ensure that his assessments, decisions
and courses of treatment were recorded contemporaneously.

The private hospital did not breach Right 4(1) as: (1) the nursing
staff administered the patient's medication appropriately; (2)
acted on requests for further medical consultations; and (3)
completed the informed consent process appropriately, having
ascertained that the patient had no further questions. There was a
misunderstanding in relation to the promise of ongoing care and
support, which did not amount to a breach of the Code.

The private hospital breached Right 4(2) in failing to ensure an
appropriate standard of clinical records, as it was required to do
more than encourage compliance with professional standards via
newsletters. The hospital failed to ensure there was an accurate
record of fluid balance, and that the patient was weighed daily.
The Commissioner also commented that the transfer to the public
hospital was poorly organised.